Journal of Trauma Management & Outcomes

BACKGROUND: Urgent surgical debridement of open long bone fractures is of paramount importance for prevention of subsequent infection. Due to limited information on the timing of this surgical procedure in Mwanza, Tanzania; the present study was conducted to evaluate the effect of early versus delayed surgical debridement on the outcome of open long bone fractures. METHODS: A prospective cohort study involving 143 patients with open long bone fractures admitted at Bugando Medical Centre (BMC) between December 2014 and April 2015 was conducted...

BACKGROUND: Severe traumatic brain injury (TBI) is a great economical and logistic problem in the health care system which reduces the quality of life and productivity of the patient. The purpose of this study is to evaluate the outcome of patients after severe brain trauma according to the course of their rehabilitation. METHODS: Patients with TBI were divided into three groups. Group A; after early rehabilitation (n = 16), B; following a standard rehabilitation procedure after work accidents (n = 34) and C; undergone standard rehabilitation procedure after accidents at home (n = 12)...

BACKGROUND: Angiography allows for excellent characterization and treatment of traumatic pseudoaneurysms. However, ultrasound-guided thrombin injection for pseudoaneurysm thrombosis allows for radiation-free treatment of superficial pseudoaneurysms and superficial expanding hematomas. METHODS: A retrospective review of 5 patient cases treated under this paradigm was performed following institutional review board approval. Outcomes following intervention were recorded and compared amongst the patient cohort...

BACKGROUND: Alcohol plays a significant role in major traumatic injuries. While the role of alcohol in motor vehicle trauma (MVT) is well described, its role and approaches to prevention in other injury mechanisms is less defined. METHODS: A 10 year retrospective examination of Alberta Trauma Registry (ATR) data was conducted on all major trauma patients (age ≥ 9 and ISS ≥ 12) from 2001-2010. The role and prevalence of alcohol is examined. RESULTS: Of 22,457 patients included in our study, only 60 %(n = 13,552) were screened for alcohol use...

BACKGROUND: The regionalization of trauma care, the Emergency Medical Treatment and Active Labor Act of 1986, the advent of Accountable Care Organizations and bundled payments have brought Level 1 trauma centers (TC) to a new crossroads. By protocol, injured patients are preferentially transferred to designated TCs when a higher level of care is indicated. Trauma transfers frequently come during off hours and may not always appear to be related to injury severity. Based on this observation, we hypothesized patients transferred from regional hospitals to Level 1 TCs would have lower injury severity scores (ISS) and unfavorable payor status...

BACKGROUND: Occult pneumothorax represents a diagnostic pitfall during the primary survey of trauma patients, particularly if these patients require early positive pressure ventilation. This study investigated the accuracy of our proposed rapid model of ultrasound transducer positioning during the primary survey of trauma patients after their arrival at the hospital. METHODS: This diagnostic trial was conducted over 12 months and was based on the results of 84 ultrasound (US) exams performed on patients with severe multiple trauma...

BACKGROUND: Prior traumatic experiences have been associated with poorer coping strategies, greater distress, and more posttraumatic stress disorder (PTSD) symptoms following a subsequent cancer diagnosis affecting their survival. However, the impact of prior physical traumatic injury on cancer survival has not been examined. METHODS: The present study matched patients from the same Level 1 Trauma center who appeared in both the trauma and cancer registries. A total of 498 patients met the criteria between 1998 and 2014 who have experienced both a diagnosis of cancer and a physical traumatic injury...

PURPOSE: Management of finger amputations of the proximal interphalangeal (PIP) joint is still controversial. Regrettably, injured PIP joints seldom regain normal active motion; thus, many investigators recommend revision amputation with skeletal injury at or proximal to the PIP joint. We report the functional outcome of patients with replantation or revascularization following complete or incomplete amputations of the PIP joint. METHODS: A total of 15 digital replantations or revascularization were performed on 11 patients (9 males and 2 females, age, 26-69 years) with severe finger injuries at the PIP joint at our Medical Center from 2010 through 2012...

BACKGROUND: Traumatic bilateral adrenal injuries are uncommon. Adrenal injuries are overall associated with worse outcome than non-adrenal injuries. However, direct comparative evidence between unilateral and bilateral adrenal injuries is unavailable in literature. This study aims to investigate clinical significance of bilateral adrenal hematomas in terms of injury severity, morbidity and mortality. METHODS: All blunt trauma abdomen patients with adrenal gland involvement on initial CECT scans of abdomen presenting to our Level 1 trauma centre over 21 months were prospectively included and followed-up...

BACKGROUND: Traumatic vascular injuries of the extremities are a major challenge especially in the third world countries. These injuries are mostly due to poor traffic laws, street crimes, firearms and blast associated injuries. We therefore would like to share our 10 years of experience in dealing with vascular injuries in Pakistan. METHODS: This was a retrospective observational study conducted in the department of vascular surgery of Liaquat National Hospital, Karachi, Pakistan...

BACKGROUND: A significant proportion of patients admitted to hospital with multiple traumas exhibit facial injuries. The aim of this study is to evaluate the incidence and cause of facial injuries in severely injured patients and to examine the role of plastic and maxillofacial surgeons in treatment of this patient collective. METHODS: A total of 67 patients, who were assigned to our trauma room with maxillofacial injuries between January 2009 and December 2010, were enrolled in the present study and evaluated...

BACKGROUND: Severe trauma to the extremities often includes a combination of fractures and soft tissue injuries. Several publications support that the patient outcome is better when skeletal stabilization is followed by early soft-tissue coverage. In an effort to optimize the treatment of these patients, we established a formalized collaboration in 2008 between the Departments of reconstructive plastic surgery and orthopedics at the Karolinska University Hospital. METHODS: A retrospective review was conducted for all patients who had suffered severe extremity trauma and received either a free or a pedicled flap for extremity reconstruction...

BACKGROUND: Lower cranial nerve (IX-XII) palsy is a rare condition with numerous causes, usually non-traumatic. In the literature it has been described only a few times after trauma, mostly accompanied by a fracture of the occipital condyle. Although these types of fractures have rarely been reported one could suspect they have been under-diagnosed. During the past decade they have been seen more frequently, most probably due to increased use of CT- and MRI-scanning. The purpose of this review is to increase the awareness of complications following injuries in the craniocervical region...

BACKGROUND: The increasing use of computed tomography (CT) scans in the evaluation of trauma patients has led to increased detection of incidental radiologic findings. Incidental findings (IFs) of the abdominal viscera are among the most commonly discovered lesions and can carry a risk of malignancy. Despite this, patient notification regarding these findings is often inadequate. METHODS: We identified patients who underwent abdominopelvic CTs as part of their trauma evaluation during a recent 1-year period (9/2011-8/2012)...

BACKGROUND: Africa has 4% of the global vehicles but accounts for about one tenth of global vehicular deaths. Major trauma in Kenya is associated with excess mortality in comparison with series from trauma centers. The determinants of this mortality have not been completely explored. OBJECTIVES: To determine the factors affecting mortality among road users in Nairobi, Kenya. METHODS: Cross-sectional study of prospectively collected data of trauma admissions at the Kenyatta National Hospital over a calendar year (2009-2010)...

BACKGROUND: In 2005, the Advanced Life Support (ALS) teams delivering pre-hospital care in RegionSkane in southern Sweden received additional support by physicians, who were part of "Pre-hospital acute teams" (PHAT). The study objective is to compare the incidence of pre-hospital medical interventions for trauma-patients cared for by conventional ALS teams and patients who received additional support by PHAT. METHODS: Trauma patients with Injury Severity Score (ISS) >9 were identified retrospectively in the national quality registry KVITTRA at three hospitals in RegionSkane, for the time period October 2005 to December 2008...

UNLABELLED: Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). AIM: This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP measurement techniques, identify current management and discuss the implications of IAH and ACS for nursing practice. A search of the electronic databases was supervised by a health librarian...

We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury. The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis. Radiologists and Trauma Physicians should be aware that post shotgun injury, the likelihood of an embolised shot pellet is increased compared to other types of firearm missile injury, and should therefore search away from the site of injury to find such missiles...

INTRODUCTION: Hepatic pseudoaneurysm (HPA) is a rare complication after liver trauma, yet it is potentially fatal, as it can lead to sudden severe haemorrhage. The risk of developing posttraumatic HPA is one of the arguments for performing follow-up CT of patients with liver injuries. The aim of this study was to investigate the occurrence of HPA post liver trauma. METHODS: A retrospective study from 2000-2010 of conservatively treated patients with blunt liver trauma was performed to investigate the incidence and nature of HPA...

BACKGROUND: Although extensive research for the optimal treatment of clavicle fractures has been performed, comparative studies between monotrauma and polytrauma patients are lacking. OBJECTIVE: To compare fracture distribution and treatment in monotrauma and polytrauma patients with a clavicle fracture. METHODS: Single center retrospective cohort study. Fractures were classified by the Robinson classification. Monotrauma patients sustained only a clavicle fracture or a clavicle fracture plus a minor abrasion, hematoma, or superficial skin lesion leading to an Injury Severity Score (ISS) of 4 or 5 respectively...